Cognitive rehabilitation to improve functioning in Veterans following COVID-19

2-8% of the US population report "long COVID" symptoms - including "brain fog," thinking difficulties, memory problems, and psychiatric symptoms such as sleep disturbance, anxiety, and depression. Rates of post- COVID-19 symptoms are nearly double in the Veteran population. These cognitive symptoms contribute to functional impairments, reduced quality of life, poorer self-reported health status, psychological distress, delayed return to work, new onset disability, reduced community integration, and increased healthcare utilization. One promising treatment to improve both everyday functioning and cognition secondary to post- COVID-19 symptoms is Compensatory Cognitive Training (CCT). Previous studies have found that CCT is feasible, acceptable, and efficacious in Veteran populations with multiple sources of cognitive dysfunction. The proposed CDA provides a golden opportunity to evaluate CCT for Veterans with prolonged COVID-19 symptoms (CCT-C), compared with a robust control condition, Holistic Cognitive Education (HCE). The project closely aligns with current RR&D priorities, by "examining COVID-19-specific rehabilitation interventions and responses to treatment" and by addressing "late or delayed effects of secondary conditions related to COVID- 19 infections on impairment and disability." Specific aims are 1) to conduct a pilot randomized controlled trial of remote CCT-C with 70 Veterans (35 CCT-C, 35 HCE) with post-COVID-19 cognitive symptoms to examine feasibility, acceptability, and initial efficacy; 2) to examine the preliminary efficacy of CCT-C in this population on overall functioning, as measured by the World Health Organization's Disability Assessment Schedule (WHODAS 2.0), performance-based measures of functional capacity, and secondary outcomes (cognitive performance, quality of life, self-reported cognitive problems, psychiatric symptoms, sleep disturbance, and engagement in work/community activities); and 3) to explore moderators of outcome (e.g., age, initial COVID- 19 severity, baseline cognitive functioning, presence of PTSD/mTBI history; biomarkers related to COVID-19 infection). The candidate, Dr. Tara Austin, is currently a Postdoctoral Fellow at the VA San Diego Healthcare System. The overarching objective of Dr. Austin's Career Development Award-2 (CDA-2) research plan is to build on her previous clinical and research experience in interventional neuropsychology and establish her research career focused on cognitive rehabilitation treatments for Veterans. Specifically, her training plan has been designed to develop expertise in adapting cognitive rehabilitation treatments for novel populations exposed to a range of chemical, physical, environmental, and infectious hazards, including exposure to novel infectious diseases, such as COVID-19. Her proposed training includes training in cognitive rehabilitation (Dr. Twamley), clinical trial methodology (Drs. Twamley and Thomas), cognitive and functional outcomes (Drs. Twamley, Ford, and Wynn), biomarkers associated with neuroinflammation (Drs. Ford and Pulliam), and advanced statistical techniques (Dr. Thomas). This training will support Dr. Austin's career as an independent VA research scientist with expertise in developing and evaluating interventions to improve functioning and quality of life in Veterans with cognitive symptoms secondary to exposures or illnesses such as COVID-19.